静脉注射心房利钠肽对首次前壁急性心肌梗死患者心脏交感神经活动及左心室重构的影响。
Effects of intravenous atrial natriuretic peptide on cardiac sympathetic nerve activity and left ventricular remodeling in patients with first anterior acute myocardial infarction.
作者信息
Kasama Shu, Toyama Takuji, Hatori Takashi, Sumino Hiroyuki, Kumakura Hisao, Takayama Yoshiaki, Ichikawa Shuichi, Suzuki Tadashi, Kurabayashi Masahiko
机构信息
Department of Cardiovascular Medicine, Gunma University School of Medicine, Maebashi, Japan.
出版信息
J Am Coll Cardiol. 2007 Feb 13;49(6):667-74. doi: 10.1016/j.jacc.2006.09.048. Epub 2007 Jan 26.
OBJECTIVES
We sought to evaluate the effects of atrial natriuretic peptide (ANP) on cardiac sympathetic nerve activity (CSNA) and left ventricular (LV) remodeling in patients with first anterior acute myocardial infarction (AMI) after primary coronary angioplasty.
BACKGROUND
The activation of the renin-angiotensin-aldosterone system (RAAS) prevents the uptake of norepinephrine in the myocardium. Atrial natriuretic peptide, a circulating hormone of cardiac origin, has vasodilatory and diuretic properties, and can inhibit the RAAS.
METHODS
We studied 50 patients with first anterior AMI who were randomly assigned to receive ANP (group A) or isosorbide dinitrate (group B) before and after primary coronary angioplasty. The ANP or ISDN was continuously infused >48 h. The extent score (ES) was determined from 99mTc-pyrophosphate scintigraphy to evaluate the area of initial myocardial damage 3 to 5 days after primary angioplasty. The LV end-diastolic volume (LVEDV) and LV ejection fraction (LVEF) were determined by left ventriculography 2 weeks later. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS), and washout rate (WR) were determined from 123I-meta-iodobenzylguanidine scintigraphy after 3 weeks.
RESULTS
After primary angioplasty, age, gender, risk factors, peak serum creatine phosphokinase concentration, recanalization time, and ES were similar in the 2 groups. However, in group A (n = 25), the TDS was significantly lower (34 +/- 8 vs. 41 +/- 8; p < 0.05), the H/M ratio was significantly higher (1.96 +/- 0.18 vs. 1.74 +/- 0.23; p < 0.05), and the WR was significantly lower (35 +/- 8% vs. 44 +/- 12%; p < 0.005) than in group B (n = 25). Moreover, the LVEDV and LVEF in group A were better than in group B (LVEDV: 85.5 +/- 28.5 ml vs. 106.3 +/- 39.4 ml [p < 0.05]; LVEF: 47.9 +/- 10.2% vs. 41.5 +/- 11.8% [p < 0.05]).
CONCLUSIONS
Intravenous ANP improves CSNA and prevents LV remodeling in patients with first anterior AMI.
目的
我们旨在评估心房利钠肽（ANP）对首次前壁急性心肌梗死（AMI）患者在接受直接冠状动脉血管成形术后心脏交感神经活动（CSNA）和左心室（LV）重构的影响。
背景
肾素 - 血管紧张素 - 醛固酮系统（RAAS）的激活会阻止去甲肾上腺素在心肌中的摄取。心房利钠肽是一种源自心脏的循环激素，具有血管舒张和利尿特性，并能抑制RAAS。
方法
我们研究了50例首次前壁AMI患者，这些患者在直接冠状动脉血管成形术前和术后被随机分配接受ANP（A组）或硝酸异山梨酯（B组）治疗。ANP或ISDN持续输注超过48小时。通过99mTc - 焦磷酸盐闪烁显像确定范围评分（ES），以评估直接血管成形术后3至5天初始心肌损伤的面积。2周后通过左心室造影确定左心室舒张末期容积（LVEDV）和左心室射血分数（LVEF）。3周后通过123I - 间碘苄胍闪烁显像确定延迟心脏/纵隔计数（H/M）比值、延迟总缺损评分（TDS）和洗脱率（WR）。
结果
直接血管成形术后，两组患者的年龄、性别、危险因素、血清肌酸磷酸激酶峰值浓度、再通时间和ES相似。然而，在A组（n = 25）中，TDS显著更低（34±8 vs. 41±8；p < 0.05），H/M比值显著更高（1.96±0.18 vs. 1.74±0.23；p < 0.05），WR显著更低（35±8% vs. 44±12%；p < 0.005），均优于B组（n = 25）。此外，A组的LVEDV和LVEF也优于B组（LVEDV：85.5±28.5 ml vs. 106.3±39.4 ml [p < 0.05]；LVEF：47.9±10.2% vs. 41.5±11.8% [p < 0.05]）。
结论
静脉注射ANP可改善首次前壁AMI患者的CSNA并预防LV重构。
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